Q&A Time! Hypersensitivity and LBP | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

Q&A Time! Hypersensitivity and LBP

John Paul Guidry, who recently started his own practice has a case he needs help on.

He states: I evaluated a patient, female in 60's chronic low back pain typical hypersensitive chronic pain type. She reports pain with all motions. She is hypersensitive to certain materials in LE and reports burning pain in genitals which is also worse with certain materials MRI shows general wear and tear of spine but nothing significant. There is a positive slump and SLR only c/o tightness in hamstrings, quadrant testing reports pain in low back only, normal myo and dermatomes, normal reflexes equal bilaterally, I am relatively new to neurodynamics and in the middle of reading sensitive nervous system by Butler and Clinical Neurodynamics by Shacklock. The genitalia pain kind of throws me off from a treatment perspective she has been to multiple specialists for this without an answer and any advice on something else to test or somewhere I else I could look fore info on this would be appreciated.

John, that may be a tough case for most, here are my thoughts from the information you provided

  • be sure to check her thoracic and hip mobility, as limitations in these areas can lead to a loss of stability/motor control of the lumbar spine
    • if limited, use manual on these to get them moving accordingly
  • check repeated lumbar flexion and extension in standing
    • I had both males and females before with radiating pain into the genitals who responded to repeated extension
    • make sure you go to end range
    • pain during motion is ok, increased pain during motion is ok, as long as the pain in the lumbar spine does not remain worse when done
    • a quadrant is not enough and repeated motions often bring out a directional preference
  • The psoas may need to be released bilaterally, which often helps with both LBP, plus femoral nerve entrapment
  • also check femoral slump test (in sidelying)
Physio Answers Contributor and Women's Health PT Extraordinaire Julie Wiebe, needs to know more (as do I). She asks

  • is genital pain constant? brought on my trunk movement? pelvic movment? hip movement? sitting? standing? does it ease ever-positional? with walking? stairs? anything? 
  • With any hypersensitive situation I always look to the diaphragm to get the fight or flight to settle. Linking the D to the PF in alignment might relax structures compressing nerves
  • mechanism of injury? progression of Sx
  • status of PF function (incontinence? painful sex?)

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